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Health Policy, Healthcare Reform, Law, Medicine, Op-eds, Politics, Socialized Medicine

Be Careful about Replacing ObamaCare

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Marilyn M. Singleton, M.D., J.D.

Since the day the Affordable Care Act was enacted, we have been subjected to the “repeal and replace” mantra. Replacement offerings are basically slimmed down versions of the ACA. A few brave souls have proposed a straightforward repeal. Of course, such bills were merely making political hay since Obama would never sign away his namesake law.

Several GOP presidential candidates have doubled down on the misguided “repeal and replace” promise, including the yet-to-be-elucidated “Donaldcare.” But the real question is whether the ACA should be replaced at all.

Any healthcare “system” – new or old – is subject to the long arm of the federal government. Central control does not have a good track record for creative solutions, security, fraud control, administrative efficiency, or the ability to change personal habits.

The federal government has yet to figure out a way to comply with HIPAA’s twenty-year-old mandate to remove Social Security numbers from health insurance cards. Consequently, the mere possession of a Medicare card poses the risk of identity theft in our most vulnerable population.

And speaking of identity security, a core tool of the healthcare system is the electronic health record. Health “providers” seeing Medicare or Medicaid patients must have “meaningful use” of electronic records in their offices or face monetary penalties. However use of wireless networks for sensitive information requires sophisticated security measures most physician offices do not have. Moreover, even with the highest-level resources at its disposal, the federal government has failed to secure its own records.

The Health and Human Services (HHS) Office for Civil Rights reported 32 health data hacking incidents in 2015. Millions of people now have their medical information, Social Security numbers, and other personal identifying data compromised. According to a House Energy and Commerce Committee investigation, the HHS Inspector General reported that over the last seven years, HHS had “pervasive and persistent deficiencies across HHS and its operating divisions’ information security programs.”

Fraud and administrative errors plague the Medicare program. According to the federal Office of Management and Budget, its fiscal year 2014, “high-error” programs produced approximately $125 billion in “improper” payments, i.e., those that violated guidelines or rules in some way. Medicare Fee-for-Service alone had $45 billion in improper payments or 12.7 percent of the total. Fraud, lack of documentation, and medical necessity authentication issues are the main culprits.

Even as the Department of Justice touts its improved record of Medicare fraud convictions, the ACA’s federal Health Insurance Marketplace represented an epic failure on the fraud front. To assess the enrollment controls of the Marketplace, the Government Accountability Office (GAO) performed 18 undercover tests. During these tests, the Marketplace approved subsidized ACA coverage for 11 of the 12 fictitious GAO telephone or online applicants for 2014.

The Veterans Administration clinics debacle is a prime example of federal administrative inefficiency. The Office of Inspector General concluded “enrollment program data were generally unreliable for monitoring, reporting on the status of health care enrollments, and making decisions regarding overall processing timeliness.” The report confirmed that as of September 30, 2014 the system had some 867,000 pending records, 307,000 of which were for individuals reported as deceased by the Social Security Administration.

Finally, government attempts to mandate healthy behavior don’t work. For example, a 2015 scientific study analyzed the “Los Angeles Fast-Food Ban”, a 2008 zoning regulation restricting opening/remodeling of standalone fast-food restaurants in South Los Angeles. Data showed that consumption of fast food and obesity increased in all geographic areas from 2007 to 2012, and the increase was significantly greater in the regulated area.

Politicians need a “system” to expand central control. Central control breeds mediocrity. Government programs play to the lowest common denominator. One size fits all quickly becomes one size fits none. Call me crazy, but I want the second opinion about my treatment to come from physician, not a government bureaucrat evaluating me from his cubicle.

As Malcolm Gladwell of Tipping Point fame opined, rather than expanding insurance we should keep insurance in its proper role for “unexpected, big-ticket things.” And “the bottom end of healthcare should be a market-driven cash economy.”

Competition brings out the best in us. For example, Theranos, a company started by a Stanford freshman provides 14 accurate basic kidney/liver function tests from one drop of blood for $7.27 at Walgreens. By contrast, my insurance co-pay for lab tests is $40.

Politicians can’t fix our medical care access problems. That’s up to us. As a start, consider enlisting direct pay physicians (here, here, and here) who give personal care at reasonable prices and replace the ACA with your own healthcare system.

singletonDr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

Despite being told, “they don’t take Negroes at Stanford”, she graduated from Stanford and earned her MD at UCSF Medical School.

Dr. Marilyn Singleton then completed two years of surgery residency at UCSF, followed by an anesthesia residency at Harvard’s Beth Israel Hospital.

Dr. Marilyn Singleton was first an instructor, then Assistant Professor of Anesthesiology and Critical Care Medicine at Johns Hopkins Hospital in Baltimore, Maryland before she returned to private practice in California.

While still working in the operating room, Dr. Marilyn Singleton attended UC Berkeley Law School, focusing on constitutional law and administrative law.  She also interned at the National Health Law Program and has practiced both insurance and health law.

Dr. Marilyn Singleton has taught specialized classes dealing with issues such as the recognition of elder abuse and constitutional law for non-lawyers. She also speaks out about her concerns with Obamacare, the apology law and death panels.

Dr. Marilyn Singleton has conducted make-shift medical clinics in two rural villages in El Salvador.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012. (Audio version of the speech to AAPS doctors by Dr. Marilyn Singleton.)

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

Culture & Society, Elections, Healthcare Reform, Law, Politics

Presidential Candidates in the Year of the Sheep

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Marilyn M. Singleton, M.D., J.D.

Gong Hay Fat Choy! [Happy New Year!] The Chinese Year of the Sheep is upon us. Sheep are known for trying to make people happy and being loyal followers. Too many of our elected “leaders” have lived their careers in the Year of the Sheep.

This is also the year where potential presidential candidates surface. The candidates range from the anointed one, establishment insiders, and those pretending not to be insiders, to those on the fringe. All we now know is what the potential candidates have told us about themselves or what the media want us to know about them.

We have learned the hard way that policies are more than a catchy bumper sticker. Remember “Hope and Change”?

Hillary Clinton’s slogan thus far is “I Am Woman.” Clinton has yet to own to any responsibility in the Benghazi murders and HillaryCare trumps ObamaCare in the government takeover of medical care category. Her Wall Street connections are driving the anti-business crowd to urge non-candidate pro-federal regulation Massachusetts senator Elizabeth Warren to throw her hat in the ring.

Former Democratic Virginia senator Jim Webb is a self-described public servant, warrior, author, and filmmaker. He correctly notes that people want solutions, not rhetoric. His pitch is that he can bring us together, as he spent four years in the Reagan administration.

Former Florida governor Jeb Bush was indeed popular but increased spending and supports federal intervention in education. He said on ABC’s This Week that Republicans should stop trying to defund ObamaCare and instead let implementation of the law prove that it won’t work. Of course, by then it will be too late.

Wisconsin governor Scott Walker is known for budget cutting and standing up to public-sector unions. He did not buy into the Affordable Care Act’s expansion of Medicaid. Instead he reformed BadgerCare (Wisconsin’s Medicaid) by moving people out of BadgerCare onto the ACA’s marketplace. His goal was to get more people working and fewer people dependent on the government. The media has publicized Walker’s lack of a college degree and his 2010 scandal over apparently urging his employees to post comments promoting him and his record on news websites.

Governor Chris Christie was a breath of fresh air with his assertive no-nonsense style. But New Jersey is not in great economic shape, with high unemployment and a poor credit rating. While stating that he was “no fan of the Affordable Care Act”, Christie felt leadership dictated that he accept federal Medicaid funds to help the state’s low-income residents. After all, the federal government would pay the full cost of Medicaid expansion for three years and 90 percent of the cost after that. But how would he save money as the head of the federal government?

Senators Marco Rubio and Ted Cruz are engaging speakers and add some diversity. Rubio has said he will vote to defund the Affordable Care Act. Cruz’s conservative principles are considered solid and by some, extreme.

Having physicians in the mix is encouraging, but not dispositive. Remember Howard Dean. Senator Rand Paul to his credit has opened himself up to traditionally unfriendly crowds. He is clearly in favor of limited government, and against ObamaCare. Neurosurgeon and professor emeritus Ben Carson made it clear at the National Prayer Breakfast that he has no use for ACA. But his lack of political experience may haunt him as he speaks his mind in an unvarnished way.

Ohio two-term Ohio governor John Kasich supported Medicaid expansion under ACA even after the legislature issued a line item veto.

Indiana governor and former senator Mike Pence has a strong resume, and Indiana has a great economy. Pence pledged to reduce regulations but agreed to Medicaid expansion under the ACA.

Former CEO Carly Fiorina is relatively unknown, and Hewlett Packard did not exactly thrive under her stewardship.

Some retreads include Mike Huckabee, popular with social conservatives, who increased spending and taxes while governor of Arkansas, and former Texas governor Rick Perry, who performed miserably last time around.

Many others have expressed interest. The more choice the better.

Politics is not for other people; it pertains to us and has a palpable effect on our lives. For example, despite federal expenditures of $415 billion per year, Medicaid patients have decreased access to care, longer waiting times for appointments than privately insured patients, and more emergency room visits to receive non-urgent care.

Let’s make our New Year’s resolution to go beyond a superficial look at the candidates. With respect to American medicine, we will not tolerate a politician who would rather listen to a flock of railbirds enamored with regulatory control than meet with committed members of the medical community who have easily implemented alternatives to the current medical care delivery model.

 

singletonDr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

While still working in the operating room, Dr. Marilyn Singleton attended UC Berkeley Law School, focusing on constitutional law and administrative law. She also interned at the National Health Law Program and has practiced both insurance and health law.

Dr. Marilyn Singleton has taught specialized classes dealing with issues such as the recognition of elder abuse and constitutional law for non-lawyers. She also speaks out about her concerns with Obamacare, the apology law and death panels.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton

Health Policy, Healthcare Reform, Law, Medicine, Politics

Jonathan Gruber – Stupidity, Lies, and Videotape

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By Marilyn M. Singleton, MD, JD

Lies and promises have been a staple of politics since its inception. As Plato observed, “propaganda, that is, ‘enticing people into a change of opinion by promises of pleasure’ and deceit always go together.”

ObamaCare’s empty promises have become not-so-funny household jokes: health law negotiations would be live on C-SPAN, if you like your doctor you can keep your doctor, the law will not add a single dime to the deficits, the average family will save $2,500 on their premiums, and on and on and on. Now the deceit has been exposed.

My heartfelt thanks go to Jonathan Gruber, Ph.D., MIT economics professor and a developer of the Affordable Care Act for speaking the ugly truth. The miracle of the internet has provided undeniable proof that the ACA was a scam perpetrated on the American public.

Gruber’s speeches in various venues confirm what many of us already knew: the ACA is a flawed, unreadable, misleading bill that garnered support based on propaganda and clever but false talking points.

Gruber’s Washington University of St. Louis lecture on October 4, 2013 to college students was a real eye-opener. In discussing how subsidies were critical to the success of health reform, Gruber revealed, “the dirty secret” that RomneyCare was paid for by the federal government to the tune of $450 million a year.

Since there was no other government coffer to tap to finance the ACA’s subsidies, multiple taxes are included in the law to generate revenue.

There is no question that we need a discussion and reform of inconsistencies in the tax code regarding employer versus individual payment of health insurance premiums. However, Gruber settled on imposing a 40 percent tax on high benefit Cadillac health plans.

Why? Because “Americans are too stupid to understand the difference” between a tax break and a tax.

Gruber crystallized his jaded views during a panel discussion at the Annual Health Economics Conference at the University of Pennsylvania’s Leonard Davis Institute of Health Economics on October 17, 2013 Gruber said,

This bill was written in a tortured way to make sure CBO did not score the mandate as taxes. If CBO scored the mandate as taxes, the bill dies… In terms of risk rated subsidies, if you had a law which made explicit healthy people pay in and sick people get money, it would not have passed…

Lack of transparency is a huge political advantage. And basically, call it the stupidity of the American voter or whatever, but basically that was really critical for the thing to pass.

Speaking at the University of Rhode Island on November 1, 2012, Gruber proudly said, “It’s a very clever, you know, basic exploitation of the lack of economic understanding of the American voter.” Gruber’s comments are reminiscent of another arrogant bully, Adolph Hitler: “The receptivity of the masses is very limited, their intelligence is small.”

And then the denials from the White House and the pro-ACA folks came in. House minority leader Nancy Pelosi said, “I don’t know who he is; he didn’t help write our bill.” However on November 5, 2009, she publicly referred to Gruber’s expertise while claiming the ACA would insure 36 million people and would bring down insurance rates.

President Obama dodged the question of whether he had met with Gruber by saying that Gruber was “some advisor who never worked on our staff.” His advice came with a $400,000 price tag.

In a June 13, 2012 PBS Frontline interview Gruber said, “I then worked with the Obama administration and Congress to help develop the Affordable Care Act, or Obamacare. . . The next time I see him [Obama] is summer 2009… We had a meeting in the Oval Office with several experts.” At the Washington University lecture, Gruber unambiguously stated, “I helped write the law.”

In Washington, D.C. truth has become a veritable unicorn. Brazen disrespect by elitist know-it-alls has become the norm. Let your congresspersons know you are not stupid. Ask them to repeal the ACA and support strategies that focus on patient choice and transparency of costs.

Dr. Marilyn SingletonDr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

While still working in the operating room, Dr. Marilyn Singleton attended UC Berkeley Law School, focusing on constitutional law and administrative law. She also interned at the National Health Law Program and has practiced both insurance and health law.

Dr. Marilyn Singleton has taught specialized classes dealing with issues such as the recognition of elder abuse and constitutional law for non-lawyers. She also speaks out about her concerns with Obamacare, the apology law and death panels.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton

Culture & Society, Elections, Healthcare Reform, Media & Press, Medical Ethics, Medicine, Op-eds, Politics

Deceptive Political Debates Elicit Unproductive Emotions

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Emotionitis: a Political Malady

By Marilyn M. Singleton, M.D., J.D.

Today’s political debates are extremely polarized and emotional. One person’s charming, clever, and assertive is another’s manipulative, cunning, and ruthless.

Consider the opposing perspectives on some of the most important issues:

  • Did the politician lie or merely misspeak?
  • Is the NSA perpetrating an obscene invasion of privacy or deploying a crucial tool against terrorism?
  • Is supporting voter identification laws resurrecting Jim Crow or ensuring legitimate votes are not diluted by fraudulent votes?
  • Do federal regulations stifle business and entrepreneurship or do they ensure Americans’ safety?
  • Why is it racist to disagree with the policies of President Obama or Attorney General Holder, but reasonable to disagree with Condoleezza Rice or Clarence Thomas?
  • Why is interest in the possible long-term effects of Hillary Clinton’s brain concussion intrusive, sexist, and unfair, but delving into Sarah Palin’s medical records to determine if she had actually given birth to her new baby is manifestly valid? (I guess it’s a political crime to be petite.)
  • Have you cornered the market on compassion if you believe Medicaid provides good health care, or are you a heartless subhuman if you believe Medicaid traps lower income individuals in a two-tiered health system?

Marcus Aurelius said, “Everything we see is perspective and not the truth.” In 1880, William James, a Harvard physician, philosopher, and “father of psychology” observed, “As a rule we disbelieve all the facts and theories for which we have no use. A great many people think they are thinking when they are really rearranging their prejudices.”

To analyze why we cement our beliefs in the face of contrary facts, psychologist Leon Festinger proposed the theory of cognitive dissonance: people seek consistency in their beliefs and perceptions because it is uncomfortable to have inconsistent ideas. For example, you like President Obama, so how can you dislike ObamaCare?

One unconscious mechanism we use to ignore facts is “motivated reasoning.” Here, we process information such that the influence of our beliefs outweighs new facts in forming seemingly reasonable conclusions. In other words, our brain’s goal is not accuracy, but defense of beliefs.

Adding to the difficulty in changing our minds, we tend toward “confirmation bias,” i.e., listening only to those who confirm our preconceptions. Another psychological tool is post-purchase rationalization. Anyone who purchased a time-share or hot-off-the-shelf Betamax knows what that is.

Modern technology confirms Professor James’s observation. An Emory University study analyzing functional magnetic resonance imaging (fMRI) found that the areas in the brain regulating emotion and conflict resolution light up when subjects were questioned about their political beliefs. The part of the brain most associated with reasoning was quiet.

Emotionitis and ideological divisiveness should never have been allowed to take over the healthcare reform debate. A good relationship with your doctor is just too important to health and peace of mind. And there are actually large areas of agreement.

A mere 19 percent of Americans say that they trust Washington “to do what is right” just about always or most of the time according to Pew Research Center.

Yet, while we think the government is made of incompetent self-serving fools, we trusted it with our health care system. Perhaps enough first-hand experience with grossly higher premiums, deductibles, and co-pays and limits on patients’ choice of physicians jolted people into reality. The support for the Affordable Care Act (ACA) is at an all time low of 26 percent according to the latest Associated Press poll.

There is also almost universal agreement that American medicine has serious problems. The right approach would have been to seek dispassionate analysis of the causes instead of leaping into the Affordable Care Act.

Our system relies heavily on public and private third party payers and muscles out the one-on-one relationship between patient and doctor. ACA just makes it worse. ACA’s “health insurance” is not medical care—and it isn’t insurance either.

Real insurance—unlike ACA and most of pre-ACA coverage also—is affordable because it is designed to financially protect against catastrophes, not routine necessities. Individualized affordable medical care can be achieved through expansion of health savings accounts, direct pay (which cuts out third-party overhead), charity care, and major medical insurance.

We need to overcome our emotional attachment to the false promise of security through third-party coverage.

Dr. Marilyn SingletonDr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

While still working in the operating room, Dr. Marilyn Singleton attended UC Berkeley Law School, focusing on constitutional law and administrative law. She also interned at the National Health Law Program and has practiced both insurance and health law.

Dr. Marilyn Singleton has taught specialized classes dealing with issues such as the recognition of elder abuse and constitutional law for non-lawyers. She also speaks out about her concerns with Obamacare, the apology law and death panels.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton

Health Policy, Law, Medicare, Medicine, Op-eds, Politics

Government Regulations Leading to Medicare Overlords

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The Road to Serfdom is Paved with Good Intentions

by Marilyn M. Singleton, M.D., J.D.

What do TSA groping, NSA data-mining, and mercury-laced fluorescent light bulbs have to do with keeping your doctor? They are the products of seductively entitled but flawed laws. As Daniel Webster said, “good intentions will always be pleaded for every assumption of authority.”

The Transportation Security Administration and the National Security Agency restrain our liberty under the auspices of the Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism Act of 2001 (PATRIOT Act). The Energy Independence and Security Act is phasing out incandescent bulbs.

The Patient Protection and Affordable Care Act (ACA/ “ObamaCare”) sounds as though our best interests were at the heart of the legislation. But so far, the 400,000-word law that nobody read has spawned some 12 million words in regulations. Now these regulations that even fewer people read are coming between you and that doctor you were promised you could keep.

The modern-day mission creep began with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). To “safeguard the privacy of protected health information,” HIPAA’s Administrative Simplification Standard mandated the use of the National Provider Identifier (NPI) for “covered entities,” i.e., those who electronically transmit health information.

The NPI extended its reach to “non-covered” physicians who neither sent nor intended to send claims for services they furnished to private insurers or government programs. Without an NPI on the paperwork to refer patients for diagnostic testing, a claim could be denied.

Obtaining an NPI was a small concession to Big Brother for physicians who were not enrolled in the Medicare program. After all, even if their patients chose to pay their personal doctor out of pocket, they had paid their Medicare premiums and deserved the benefit of that insurance for other services and supplies.

For the overlords at Medicare, an NPI was no longer sufficient. The ACA specifically requires physicians/practitioners to enroll in or officially opt out of the Medicare Program to order medical supplies and home health services and have these claims accepted. To “ensure program integrity,” a gem of a catchall ACA provision (section 6405(c)) gives the Secretary of Health and Human Services (HHS) unilateral authority to extend this mandate to “all other categories of items and services.”

Wasting no time, HHS added clinical laboratory and radiology tests to the mandate via regulations. Despite the longstanding policy of approving prescriptions dispensed under applicable state law, a new ACA-proposed rule adds medications covered by a Medicare Part D drug plan to the enroll/opt-out mandate.

Physicians are bullied into bowing at the altar of bureaucracy or having Medicare deny payment for their patients’ claims for pharmaceuticals and other providers’ services.

So to protect their patients financially, physicians acquiesce to more rigmarole. In short, opting out requires making payment contracts with each patient that must be available for inspection, and filing a 12-point affidavit with the government. The entire process must be repeated every two years.

And add this little buried nugget to the pile. Next year, health plans may only contract with providers who have “mechanisms to improve health care quality as the Secretary may by regulation require.” Only Heaven knows how this will work. The current “voluntary” Physician Quality Reporting System forms are so complex that despite the specter of financial penalties few physicians respond.

Studies have shown that the government with its mainly process-oriented quality measures differs with patients in their perceptions of quality care. Indeed, the government cautions that completing forms is no substitute for local quality-improvement efforts.

Physicians are regulated and disciplined by the medical boards of the states in which they practice. Nonetheless, the federal government wants to track physicians with their own Medicare GPS. Whether enrolled or opted out, the government’s mission is accomplished: controlling physicians through layer upon layer of paperwork.

The effort to control physicians and patients’ choices one rule at a time is backfiring. Patients are seeking out “high value” physicians who are willing to be innovative in providing individualized care and affordable payment options. They know that real “administrative simplification” is bypassing the middlemen with an open market that has transparent costs.

Dr. Marilyn SingletonDr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

While still working in the operating room, Dr. Marilyn Singleton attended UC Berkeley Law School, focusing on constitutional law and administrative law. She also interned at the National Health Law Program and has practiced both insurance and health law.

Dr. Marilyn Singleton has taught specialized classes dealing with issues such as the recognition of elder abuse and constitutional law for non-lawyers. She also speaks out about her concerns with Obamacare, the apology law and death panels.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton

Culture & Society, Health Policy, Healthcare Reform, Medicine, Op-eds, Politics

Warning: Government Can Be Harmful to Your Health

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By Marilyn M. Singleton, MD, JD.

Trust in our government was a mere 19 percent in 2013 according to Pew Research Center. Not surprisingly, 56 per cent of Americans think it is not the government’s responsibility to provide a healthcare system. Waivers, favors, off-the-cuff rule changes, and the bungled launch of the Affordable Care Act website validate that distrust.  Bureaucratic incompetence and cronyism are not the only reasons we should be wary of government involvement in our medical care.

The federal government has a checkered history when it comes to medical judgments. We now cringe at the words of the revered Supreme Court Justice Oliver Wendell Holmes in the 1927 case, Buck v Bell upholding Virginia’s sterilization law for the institutionalized “feeble-minded.” “[Carrie Bell’s] welfare and that of society will be promoted by her sterilization.

It is better for all the world if, instead of waiting to execute degenerate offspring for crime or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. . .Three generations of imbeciles are enough.” In fact, Carrie’s mother was a prostitute, but not feeble-minded. After Carrie’s release she maintained a job as a domestic worker and became an avid reader. Her “feeble-minded” daughter was on her school’s honor roll.

Let’s recall the appalling Tuskegee Syphilis Study lasting from 1932 to 1972.  The U.S. Public Health Service used 400 hundred mainly poor, illiterate black sharecroppers with syphilis as lab animals. They were told they had “bad blood,” but not that they were actually suffering from a serious but treatable disease. All subjects succumbed to untreated syphilis so our government could track the natural progression of the disease.

The U.S. Navy sprayed the presumably harmless bacterium, Serratia marcescens, over San Francisco in 1951 in a biological warfare test. Numerous residents contracted pneumonia-like illnesses resulting in at least one death. The experiments came to light in the 1977 Senate hearings on Health and Scientific Research. Two hundred thirty nine populated areas, including Minneapolis, St. Louis, Washington D.C.’s National Airport, and New York’s subway system, had been contaminated from 1949 to 1969 when President Nixon terminated the program.

In 1989, a Centers for Disease Control and Prevention (CDC)-sponsored study tested an experimental measles vaccine on 1,500 six-month old Black and Hispanic babies in Los Angeles. The CDC admitted in 1996 that parents were never informed that the vaccine was experimental.

According to the Department of Health and Human Services (HHS), lax oversight at the Stratton Veterans Affairs Medical Center in Albany, New York, allowed cancer research coordinator Paul Kornak from 1999 to 2003 to “dishonest[ly] handle research records and demonstrate a complete disregard for the well-being of vulnerable human subjects under his care.” Kornak pleaded guilty to criminally negligent homicide.

In another vein, the degree of political underpinnings in government health policies is unknown. Agencies such as the United States Preventive Services Task Force, self-described as an “independent panel of non-federal experts in prevention and evidence-based medicine,” submit recommendations to the HHS Secretary. Even assuming the recommendations are grounded in science, the Secretary is an arm of the executive branch, so in creeps politics.

This leads us to the question of whether we can always trust “evidence-based medicine.” Reporting bias is systemic in medical literature. A 2012 Cochrane independent review found that company-sponsored trials were more likely to report favorable efficacy results compared with non-industry sponsored studies.  Even in academic studies positive results are more likely to be published. A 2009 analysis of 18 surveys by multiple authors found 34 percent of researchers admitted to “questionable research practices.”

Recently, a large analysis of “secure” studies found the European guideline recommending liberal use of peri-operative beta-blockers for non-cardiac surgery in fact caused a 27 percent increase in mortality or some 800,000 deaths over 5 years. The guidelines were based on trials tainted by scientific misconduct by the principal investigator, Don Poldermans, who was also chairman of the committee that drafted the guideline.

Government intervention in medicine can be harmful to your health. Rigid rules and restrictive drug formularies are advanced based on consensus, leaving no room for individualized treatments. We want physicians whom we can trust to be open, honest critical thinkers, not “providers” who are government puppets.

Dr. Marilyn SingletonDr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

While still working in the operating room, Dr. Marilyn Singleton attended UC Berkeley Law School, focusing on constitutional law and administrative law. She also interned at the National Health Law Program and has practiced both insurance and health law.

Dr. Marilyn Singleton has taught specialized classes dealing with issues such as the recognition of elder abuse and constitutional law for non-lawyers. She also speaks out about her concerns with Obamacare, the apology law and death panels.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton

Culture & Society, Health Policy, Healthcare Reform, Medicine, Op-eds, Politics, Socialized Medicine

ObamaCare Is About Your Money, Not Your Health

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By Marilyn M. Singleton, M.D., J.D.,

“Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly, and applying all the wrong remedies.” Groucho Marx

The politics of selling the Affordable Care Act (ACA) focuses on promising health and wellness. Somehow, having “coverage” is supposed to get you to a primary care doctor, who will keep you healthy. And if he doesn’t, he will be held accountable by not being paid.

The fact is that “healthcare reform” is not going to cure America’s health problems.

Physicians, think tanks, and politicians are pointing out a myriad of problems with ACA. But most of them miss the main point, which starts with calling it “healthcare reform.” The term, and the conversation about it, conflates health care and medical care. But they are not the same thing. Individuals are in charge of their own health care. Physicians provide medical care to those who become sick.

Health reform begins with making it clear that individuals’ health is in their own hands. The relationship between personal behavior and health is clear. Almost all of the illnesses that we can prevent are related to smoking, over-eating, lack of exercise, alcohol or drug abuse, high-risk behavior, or too much sun exposure.

According to the CDC, 19 percent of all U.S. adults (43.8 million people) smoke tobacco. Almost one third of adults living below the poverty line smoke. Adverse effects include heart and vascular disease, stroke, emphysema, bronchitis, and cancer (lung, oral, esophageal, and likely bladder, kidney, and pancreas). Smoking tobacco is responsible for almost $200 billion in lost productivity and medical care expenditures per year.

Under ACA, doctors will check a box saying they asked about smoking and counseled people to quit. But the decision is up to the patient.

One third of American adults and 17 percent of children are obese. Consequences include fatty liver disease, type 2 diabetes, heart disease, high blood pressure, stroke, gallbladder disease, osteoarthritis, breathing problems, sleep apnea, pregnancy complications, and increased surgical risk. In 2011, the estimated annual medical care costs of obesity-related illness were nearly $200 billion, or 21 percent of annual medical spending in the United States.

Such costs are expected to rise if we allow today’s obese children to grow into obese adults. Obesity must not become the new normal. Indeed, a recent study concluded that since black women are more likely than white women to be satisfied with their weight and have less social pressure to lose weight, merely maintaining their current level of obesity was a success!

Prevention of obesity occurs at home: in the kitchen, at the dinner table, and while shopping. Not in the doctor’s office.

One-fourth of American adults don’t participate in any physical activities. Exercise can lower the risk of heart disease, stroke, dementia, colon cancer, breast cancer in post-menopausal women, and endometrial cancer.

More than half of all cancers related to lifestyle factors: 25-30 percent to tobacco, and 30-35 percent to obesity, physical inactivity, and poor nutrition. Certain cancers are related to sexually transmitted diseases such as hepatitis B, human papillomavirus infections (genital warts), or human immunodeficiency virus (HIV). Many skin cancers are caused by sun exposure.

We will have healthier people only if patients value their own health as much as good doctors do. And doctors must practice what they preach—who is going to listen to an obese doctor or nurse?

Some patients place a higher priority on enjoying risky behavior than on their health. ACA will not make them healthy. It only shields them somewhat from the consequences of their actions by forcing people who do take care of their health to share their costs.

Government cannot make us healthy, not even by trying to prohibit overindulgence or bad habits. Certainly, ACA’s massive new regulations, erosion of privacy, and higher taxes don’t bring health. But ACA’s subsidies compound our unhealthy reliance on government.

ACA redistributes the money flowing through the system. But your health care is still your responsibility. We can make others share the health plan premiums, but the pain and suffering are still the patients’ to endure.

Dr. Marilyn SingletonDr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

While still working in the operating room, Dr. Marilyn Singleton attended UC Berkeley Law School, focusing on constitutional law and administrative law. She also interned at the National Health Law Program and has practiced both insurance and health law.

Dr. Marilyn Singleton has taught specialized classes dealing with issues such as the recognition of elder abuse and constitutional law for non-lawyers. She also speaks out about her concerns with Obamacare, the apology law and death panels.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton

Culture & Society, Doctors, Medicine, Op-eds, Politics

Black History Month Tribute: Strength, Persistence, Talent

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Author/contributor:  Marilyn M. Singleton, M.D., J.D. 

Black history in American has certainly had its ups and downs. It’s troubling when, for political theater, those who should know better fail to emphasize the inspirational stories that highlight the strengths of blacks and the humanity of whites.

While it is undeniable that cruelty and suffering are part of this country’s history, at some point it is counterproductive to paint blacks as weak victims of the white man’s callousness.

There were always free blacks in America (including my family). Indeed, in 1641, Mathias De Sousa, an African indentured servant who came from England with Lord Baltimore, was elected to Maryland’s General Assembly. The first census of 1790 counted 19 per cent black Americans, 10 per cent of whom were free.

Black Americans served on both sides during the Revolutionary War. The British promised freedom to slaves belonging to Patriot masters who served. Because of his manpower shortages, George Washington lifted the ban on black enlistment in the Continental Army in January 1776, creating his so-called “mixed multitude,” which was 15 per cent black. Economist Walter Williams is so correct that necessity can overcome prejudice.

Nestled in the back of some folks’ minds was (is?) the notion that blacks were not as intelligent as whites. They certainly couldn’t have had the smarts to be doctors. James Derham (c. 1757-1802?), born a slave in Philadelphia, proved the naysayers wrong.

He was the first known black American physician, although not professionally trained in medical school. As was common at the time, physicians were trained in apprenticeships. Young Derham was fortunate that his three early masters were physicians who taught him to read and write.

Derham’s third owner taught the young teen how to mix and administer medicines. After this owner, who had been arrested during the war for being a Tory, died in prison, Derham was sold to a British officer, and he served as a doctor to soldiers. After the war, he became the property of a Scottish physician (appropriately named Dr. Love) from New Orleans, who hired him to work as a medical assistant and apothecary.

By 1783, Derham quickly saved enough money to buy his freedom, and he set up his own medical practice in New Orleans. Derham, who spoke English, French, and Spanish, was a popular and highly regarded doctor, who treated both black and white patients. By age 30, Derham earned more than $3,000 annually.

Derham’s medical paper on his success in treating diphtheria caught the attention of Benjamin Rush, a physician who signed the Declaration of Independence, served as surgeon general of the Continental Army, and has been called “the father of American medicine.”

Rush invited Derham to Philadelphia in 1788 and was so impressed that he encouraged him to stay. There, Derham became an expert in throat diseases and in the relationship between weather and disease.

In 1789, Derham returned to New Orleans, where he saved many yellow fever victims. He stopped practicing medicine in 1801, when the new city regulations required a formal medical degree to be considered a doctor. Nothing is known of his whereabouts after 1802.

The first university-trained black American physician was James McCune Smith, born in 1813 to slave parents who were emancipated by New York law. Despite his scholastic achievements at the Free African School of New York, he was denied admission to American medical schools.

When he was 19 years old, the Glasgow Emancipation Society helped Smith enroll in Scotland’s University of Glasgow. He received his B.A. degree in 1835 and his M.D. degree in 1837. A skilled debater and lecturer, Smith was a founding member of the New York Statistics Society in 1852, and was elected as an early member of the American Geographic Society.

The first American medical degree was conferred on David J. Peck, born circa 1826 into a free black family in Pittsburgh, Pa. In 1846, after studying two years with a private physician, he enrolled in Rush Medical College and graduated in 1847. Peck practiced medicine in Philadelphia for 2 years before moving to Central America to start a homeland for free blacks in Nicaragua.

Thank you, doctors, for paving the way for my grandfather, my father, and me.

Dr. Marilyn SingletonDr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

While still working in the operating room, Dr. Marilyn Singleton attended UC Berkeley Law School, focusing on constitutional law and administrative law. She also interned at the National Health Law Program and has practiced both insurance and health law.

Dr. Marilyn Singleton has taught specialized classes dealing with issues such as the recognition of elder abuse and constitutional law for non-lawyers. She also speaks out about her concerns with Obamacare, the apology law and death panels.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton

Culture & Society, Healthcare Reform, Medical Ethics, Politics

A Black Physician Reflects on the 2013 Inaugural Address

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Author/contributor:  Marilyn M. Singleton, M.D., J.D. 

Despite the Martin Luther King, Jr., holiday, many of us were too busy seeing patients to hear President Obama’s second inaugural address. It was less painful to read the transcript.

“What binds this nation together is not the color of our skin or the tenets of our faith or the origins of our names,” he stated. Then let’s end the government’s obsession with African-Americans, Hispanic-Americans, and Asian-Americans (but never European-Americans). We are all Americans. I feel some moral authority and passion on this subject as a black American whose family moved here from England in the 1600s. I am a full-blooded American!

I can’t bear to hear one more person say, “I’m so glad we have an African-American President.” How ironic: Martin Luther King, Jr., urged that we judge people by the content of their character, not the color of their skin.

The head of the Congressional Black Caucus admitted that the CBC treats the President with a “deference” not accorded to a white President, and that the CBC is “hesitant” to criticize the current President. “With 14 percent unemployment [versus 6.9 percent for whites], if we had a white president, we’d be marching around the White House.”

This Administration and/or its tools use race as a crutch when facing legitimate criticism, for example Susan Rice’s willful or incompetent misleading of Americans about the Benghazi deaths. Rep. Jim Clyburn said calling Susan Rice “unqualified” to be Secretary of State was a racist “code word.”

Curiously, “unqualified” was not a “code word” when used against Clarence Thomas in his Supreme Court hearings. It was noted that he was particularly unqualified because he had served on the D.C. Circuit for only one year and four months. God forbid we should raise the same question about Elena Kagan or Thurgood Marshall (whom Thomas replaced), who were never judges at all.

And what about the other Rice? Who can forget how a former Secretary of State, Dr. Condoleezza Rice, was maliciously attacked as a “house slave” in the Bush Administration?

We next learned that the “patriots of 1776 did not fight to replace the tyranny of a king with the privileges of a few, or the rule of the mob.” I guess President Obama and Nancy Pelosi are not part of the Spirit of ’76 since the Patient Protection and Affordable Care Act (ACA or “ObamaCare”) was rammed through Congress with a five-vote margin, 34 Democrats and all 178 Republicans voting against it.

Obama only had one open discussion session, breaking his campaign promise to have open negotiations on C-SPAN. Instead, Democrats in the White House and Congress made private, multibillion-dollar deals with hospitals, pharmaceutical companies, other special interests—and each other.

Moreover, said Obama, “Together we discovered that a free market only thrives when there are rules to ensure competition and fair play.” Rules are fine when the President makes them up along the way. ACA waivers come to mind.

“We must make the hard choices to reduce the cost of health care.” Now that we are learning how “reform” will increase costs, it is clear that naming it the Affordable Care Act was a marketing tool. The most bothersome aspect is that we don’t yet know the identity of the “choosers” who will decide whose care to ration or whose bank account to raid. It is very telling that Obama did not proudly extol the virtues of his signature legislation.

“We understand that outworn programs are inadequate to the needs of our time.” Then, Mr. President, encourage Harry Reid to act on congressional legislation that attempts to restructure Medicare and Social Security instead of deriding these efforts as throwing Granny off a cliff.

Sadly, a thread woven throughout the speech was that Obama will liberate us from our autonomous, free, yet nonetheless pathetic, unhappy existence. He asserted several times that only a select few were making it in America, and he was going to do something about that!

We can only hope that Dr. Martin Luther King, Jr., was right: “A lie cannot live.”

Dr. Marilyn SingletonDr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

While still working in the operating room, Dr. Marilyn Singleton attended UC Berkeley Law School, focusing on constitutional law and administrative law. She also interned at the National Health Law Program and has practiced both insurance and health law.

Dr. Marilyn Singleton has taught specialized classes dealing with issues such as the recognition of elder abuse and constitutional law for non-lawyers. She also speaks out about her concerns with Obamacare, the apology law and death panels.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton

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